UPC Host Family Application
Ulster Project of Cincinnati Host Family Application
Section 1: To be completed by HOST PARENTS
Host Teen's Name
Mother's Full Name
Father's Full Name
Do parents live together
If not, Father's Full Address
If not, which house will be hosting?
Mother's Email Address
Mother's Cell Phone Number
Father's Email Address
Father's Cell Phone Number
Name of Church Family Attends:
Is this a Catholic church or Protestant?
Youth Minister or Pastor
Will your host and guest teens share a room or have their own?
Have Own Rooms
Do you have any pets?
If yes, please specify:
Family's interests, activities, hobbies?
Do you have access to any special recreational facilities (pools, tennis courts, clubhouse, etc). If yes, specify.
Does anyone smoke inside your home?
Please list the names and ages of any siblings:
Recent Parent Photo (can be together or individual)
Recent Parent Photo 2 (if individual)
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